Integrated medical device and home based system to measure and report vital patient physiological data via telemedicine

ABSTRACT

An integrated “home” based system to measure and report vital patient physiological data via telemedicine is disclosed. The integrated medical device is a personal, affordable, portable medical monitor, providing multiple critical vital sign data for real-time face-to-face communication with qualified health care professionals, direct from the comfort of your home (or wherever you may be travelling), whenever you need it. It is also linked to a secure patient medical record so the patient and/or healthcare professional can collect, archive and track information and trends.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application is a continuation-in-part application and claims thebenefit and priority of U.S. patent application Ser. No. 15/914,053,filed Mar. 7, 2018, issuing on Mar. 13, 2021 as U.S. Pat. No.10,973,471, which is a continuation application of InternationalApplication no. PCT/US2016/050794, filed Sep. 8, 2016, claiming thebenefit of U.S. Provisional Patent Application No. 62/215,595, filedSep. 8, 2015, the contents of which are hereby incorporated by referencein their entirety.

FIELD

This invention is directed to telemedicine. More particularly, thisinvention is directed to a synergistic system of a software and hardwareconfiguration using a “home-based” low-powered, mobile, medicaldiagnostic device(s) with integrated medical sensors, for providingeffective telemedicine with a remote clinician.

BACKGROUND

While telemedicine is already a multi-billion dollar industry providingremote doctor-patient consultations, there is currently no inexpensive,integrated portable, “home-based” solution to connect a patient to ahealth care professional and relay fundamental physiological informationin real time during the consultation. Neither is there a single productthat can collect, record and archive this information as part of anaddressable Patient Medical Record (PMR) that the patient can authorizethe health care professional to monitor and analyze for trend anomalies,or access themselves independently.

Other “telemedicine” devices on the market today are simply singlepurpose or clumsily developed products, each with different supportsoftware (if any exists at all) and do not provide the tools necessaryfor a typical doctor-like consultation. The telemedicine industry doesnot have a unified, coherent system that is easy to use for home use(the term “home” is broadly interpreted herein to mean anynon-hospital/clinic location, therefore, home could include schooloffice, remote (non-hospital) site, etc.) by a patient that is able tocollect and integrate data from different critical vital sign monitorsand present it in real time for telemedicine sessions, or in a properlyformatted record for later use.

Therefore, in view of the above, various systems and methods aredescribed below that address the industry's deficiencies.

SUMMARY

The following presents a simplified summary in order to provide a basicunderstanding of some aspects of the claimed subject matter. Thissummary is not an extensive overview, and is not intended to identifykey/critical elements or to delineate the scope of the claimed subjectmatter. Its purpose is to present some concepts in a simplified form asa prelude to the more detailed description that is presented later.

Various embodiments provide an integrated device that is personal,easy-to-use, providing multiple critical vital sign data for real-timeface-to-face communication with qualified health care professionals,direct from the comfort of a user's home (or another location differentfrom locations of the qualified health care professionals), whenever theneed arises, and with a set of security features that link the device toa secure patient medical record so the patient and/or healthcareprofessional can collect, archive and track information and trends.

In one aspect of an embodiment, a compact, integrated, portable,diagnostic, multi-sensor telemedicine device is provided, comprising: anoblong hand-held portable housing, the housing having an upper surfacewith a domed shape, the upper surface having a longitudinally orientedrecess, the recess adapted for placement of a user's finger therein, thehousing also having a bottom surface with a planar shape; one or morepulse oximeter sensors integrated into a front end of the recess,adapted to measure at least one of an oxygen saturation, heart ratepulse, heart rate variance, and respiratory rate of a user; an otoscopecamera sensor and a light source arranged peripherally to the otoscopecamera, integrated into at a front end of the housing and substantiallyin-line with a center line of the recess; a non-contact capable infraredtemperature sensor integrated into at the bottom surface of and a rearend of the housing, adapted to measure a temperature of the user; adigital stethoscope microphone sensor integrated into the bottom surfaceof the housing, adapted to capture sound signals of the user'sheartbeat; a pair of EKG sensors integrated into the bottom surface ofthe housing, the sensors arranged on opposite sides of the stethoscope,wherein each of the above sensors' wiring and electronics are internalto the housing and non-accessible by the user; and a low powermicro-controller unit (MCU) in the housing, communicating directly orindirectly with the above sensors and forwarding an encrypted data fromthe sensors to an external Internet-connected or Cellular-connectedcommunication device, via at least one of a wired and wirelessconnection.

In another aspect of an embodiment, the device above is provided,further comprising an otoscope hood disposed on the housing and aboutthe otoscope camera, the hood having detents or attachment fixtures toenable a mounting of an otoscope ear, throat, or nose piece; and/orwherein at least one of the otoscope camera and light source areinfrared capable; and/or further comprising a computer withteleconferencing capability coupled to the telemedicine device andhaving at least one of an Internet connection and cellular connection toa remote server receiving the encrypted sensor data from the computer;and/or further comprising a software program running on theteleconferencing computer, providing teleconferencing with a medicalprofessional, wherein the encrypted sensor data is presented to themedical professional; and/or wherein the software program displays theuser's sensor data comprising at least one of pulse information, SpO2information, finger temperature, forehead temperature, stethoscopereading, and otoscope reading; and/or wherein the software programfurther displays glucose reading and blood pressure reading; and/orwherein the device includes at least one of Bluetooth, near field, andUSB communication capability; and/or wherein the device's cameraincludes a focusing lens; and/or further comprising at least two ledarrays, one of the arrays being infrared; and/or wherein the serveroperates as a HIPPA compliant cloud storage unit; and/or wherein thedevice is self-powered via an internal battery; and/or wherein power forthe device is via a USB connection; and/or wherein the remote server hasaccess to a database of Patient Medical Records; and/or wherein theremote server provides encrypted information from a database of PatientMedical Records and stored user sensor data to the medical professional;and/or wherein remote server initiates a mobile alert to the medicalprofessional or to a second medical professional; and/or wherein thesoftware program allows the medical professional to contact and shareuser data with a second medical professional; and/or wherein thesoftware program allow the medical professional to contact a secondmedical professional to join in the teleconference.

Other aspects of the invention are described in the below detaileddescription of the drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a functional diagram showing an operational layout of andexemplary MedWand system.

FIG. 2 is a side view of an exemplary MedWand user device.

FIG. 3 is a bottom perspective view of an exemplary MedWand user device.

FIG. 4 is another view of the exemplary MedWand user device, in use by auser.

FIG. 5 is a sample illustration of one possible interface, showing theuser's data to a professional.

FIG. 6 is a simplistic block diagram showing various possible data pathsin an embodiment of a MedWand system.

FIG. 7 is a block diagram illustrating the various medical hardware,computer hardware, and communication hardware that can be implemented inan embodiment of a MedWand user device.

FIG. 8 is a block diagram illustrating internal hardware andsoftware/module components in an embodiment of a MedWand user device.

FIG. 9 is a web-portal snap shot of an initial MedWand session.

FIG. 10 is a web-portal snap shot of subsequent steps in a MedWandsession.

FIG. 11 is a web-portal snap shot of subsequent steps in a MedWandsession.

FIG. 12 is a web-portal snap shot of subsequent steps in a MedWandsession.

FIG. 13 is a web-portal snap shot of subsequent steps in a MedWandsession.

FIG. 14 is a web-portal snap shot of subsequent steps in a MedWandsession.

FIG. 15 is a web-portal snap shot of subsequent steps in a MedWandsession.

FIG. 16 is a plot of a representative EKG signal detected by the MedWandsystem.

FIG. 17 is an analysis of a PPG signal detected by the MedWand System.

FIG. 18 is a diagram of a model of a heart, with respective mechanicalequivalences.

FIGS. 19A-D are front perspective view, front view, side view and bottomview illustrations of another embodiment of an exemplary MedWand device.

FIG. 20A is an illustration showing a user's hand with thumb and indexfinger gripping the exemplary device.

FIG. 20B is an illustration showing a user's hand with index fingerplaced in the sensor region.

FIG. 21 is an illustration of a temperature measurement scan of a user'sforehead.

DETAILED DESCRIPTION

What is described herein is a novel integrated low-power diagnosticmedical device, that is easy to self-administer for a patient, if sodesired, and includes a synergistic set of on-board medical tools,devices, and instruments to retrieve samples and forward medicaldiagnostic data to a first location of a medical professional and/or toanalyze to a second location.

In various embodiments, a single integrated, user-operated, “handheld”sensored medical device (sometimes referred to as a MedWand device)provides the user of the device the ability to tap into a set offundamental, vital signs measurement sensors integrated into the medicaldevice. In some embodiments, the integrated sensored medical device ordevices can be wired/wirelessly connected to a computing device, such asa PC, a laptop, a mobile communication device (such as a tablet orhand-held computer), and/or a mobile communications device, such as asmartphone. The term “integrated” is understood to refer to anarrangement wherein the components/sensors of the medical device from asingle unit, either constructed initially as a single unit or configuredby the user to result in a single unit (that is, the user can“incorporate” other/optional sensors to the medical device to form asingle operational unit). In some embodiments, the sensored medicaldevice may comprise different non-integrated sensors, as will beapparent in the following descriptions and figures. In severalembodiments, the integrated sensored medical device includes a pulseoximeter, an otoscope camera for ear examination (with attachments toallow views of the throat and nose), a contact thermometer, a digitalstethoscope, and provision to support optional and third party devicessuch as glucose or blood pressure monitors. The data collected by thesesensors can be aggregated into an encrypted file in the computing devicewhich also presents an integrated gateway and crop application for theuse (and medical professional at the other end) and sends to a secureHealth Insurance Portability and Accountability Act of 1996 (HIPPA)compliant server for storage and access, both archive and real-time.

It should be appreciated that the embodiments described hereinsignificantly differ from and improve upon currently existing options.For example, the integrated sensored medical device can be configured asa single, unified device with multiple vital sign sensors that formatsand aggregates the collected data into a secure transmittable file forreal time use by a teleconference connected health care professionaland/or for archiving for later reference and analysis. The ability tohave the primary sensors in a single unit allows data to be formattedinto a single file and data/file transmission to be performed moresecurely and rapidly. While the prior art contemplates “remote” sensingof a patient's vital signs, etc., it is accomplished through separateindividual devices, thereby making it impossible to transmit a completepackage of the disparate data collected for each test to a connectedhealthcare professional or incorporate into a single database. Moreover,the use of multiple, separate independent devices adds to the complexityof use by the user, which further prevents successful operation thereof.For example, removing one medical device and attaching a second deviceand then removing that second device and attaching a third device isarguably a non-convenient (and thus, less usable) solution for any user.Thus, user error is a constant concern in the prior art.

In view of the above, as seen in some embodiments, by providingpractically an “all-in-one,” multi-sensor, personal medical device thatis affordable, easy to use, with portable medical monitoring capability,while providing multiple critical vital sign data for real-timeface-to-face communication with qualified health care professionals, isa significant paradigm shift in the telemedicine industry. Especially asit mitigates the need for office (doctor) visits which are difficult forremote-site patients as well as for handicapped, elderly patients. Withdigitization of the medical information, it is possible to link the datato a secure patient medical record, which the patient and/or healthcareprofessional can collect, archive and track information and trends.Further, information can be rapidly transmitted to other professionalsfor 3rd party consultation. In this scenario, it is envisioned that oneprofessional may perform a real-time examination using the MedWandsystem and upon examination of the “live” data, request a secondaryprofessional to “log on” and review/manage the session with the user.The ability to timely add a second professional to the session, one whomay ask the user to perform certain examination-specific follow onactions, for a more extensive evaluation, will reduce misdiagnoses andimprove health treatment of users. In essence, routine or otherwisedoctor visits can be pre-empted with an exemplary system. It isenvisioned that medical stations having a MedWand system can be accessedat pharmacies, industrial nurse offices, schools, and even in homes, andso forth, if so desired.

It is understood that time density of measurements is a major benefit ofthe integrated sensored medical device of the present disclosure. Forinstance, normally a person may go to the doctor once or twice a yearunless the person has a specific illness or emergency. Such infrequentdoctor visits make it difficult to track the person's general health insignificant levels of granularity. However, the integrated sensoredmedical device of the present disclosure allows for a resolution of datapreviously unknown in the field. If the person can get, for example,pulse, temp, SpO2, acoustic and camera images transmitted to a hostserver frequently (i.e., weekly) the doctor can plot trends for any orall of these parameters. Doing so provides a massive amount of contextand will enable the doctor or healthcare professional to find clinicalevents that could not be detected in twice-yearly check-ups. The abilityto “monitor” a patient with an ongoing condition, without visiting aclinic or hospital is considered the “Holy Grail” in the industry and isunderstood to be revolutionary in pre-post treatment protocols.

Also, usage of the integrated sensored medical device of someembodiments may produce continuous data accumulated over time, which canbe very valuable for research purposes. In the case of medical data, theintegrated sensored medical device can be used for many kinds ofanalysis including predictive medicine and monitoring of populations bygeographic and/or demographic conditions. The integrated sensoredmedical device has the ability to collect this type of data and transferit to computing devices that can execute deep statistical analysis,making the data itself very valuable. In this way, a person's routinelytracked vital readings (e.g., pulse, temp, SpO2, acoustic, and cameraimages, etc.) can be used to identify trends with respect to theperson's past vital readings and can be used to compare the person'shistorical medical data against similar medical data from selectedpopulations of other people. Similarly, the person's historicallytracked vital readings can be compared to clinical models based on, forexample, intra-system or extra-system populations.

The exemplary medical system may be comprised of various combinations ofthe following elements presented below. However, this list of possibleconstituent elements is not intended to limit the applicable elements.Persons having ordinary skill in the art relevant may understand thereto be equivalent elements that may be substituted without changing theessential function or operation of the integrated medical system.Additionally, more or less elements may be utilized without departingfrom the spirit and scope of this disclosure.

1. Pulse Oximeter Sensor

2. Thermometer sensor (S2)

3. Digital Stethoscope Electret Condenser Microphone

4. Otoscope Camera

5. Bluetooth Receiver

6. Ultra Low Power MicroController/Processor

7. Clock circuit

8. Flash EPROM

9. SDRAM

10. USB Circuit

11. Computing Device Software

12. Secure, encrypted internet link

13. Cloud Server

14. Cloud Storage

15. Healthcare Provider Software

16. Integrated medical device Enclosure & Cables

17. Healthcare provider(s)′ computing device

18. Computing Device

Referring now to FIG. 1, which is a pictorial diagram 100 of typicalhardware utilized in an exemplary MedWand system. The MedWand integrateddevice 110 is connected to an external computer/processor 120 (shownhere, for example as a laptop) via a wired or wireless link 105. Directexternal communication to the computer/laptop 120 can be beingaccomplished by a connected or wireless link 105, however, any othersuitable communication interface/standard may be used. In someembodiments, where the MedWand integrated device 110 requires externalpower, link 105 may provide power, for example, through a wired USBconnection or equivalent, etc. In some embodiments, the link 105 linkmay be Bluetooth or via wireless/cellular/etc. The computer/laptop 120is connected via secondary link 125 (presumably, but not necessarily thepatient's home internet gateway) to a Secure Cloud Server 130, whichmanages the information transfer to a physician 150 or other medicalprofessional, via secure link 135. It should be appreciated that thelinks between the various hardware components may be physical links orwireless links, depending on implementation preference. Further, while acomputer/laptop 120 can have abilities to directly connect to the SecureCloud Server 130 (and bypass any intermediary router), anyInternet-capable device can be used for channeling information forwardedby the MedWand device 110. For example, a smart phone, tablet, or otherwireless device may be used. The computer/laptop 120 can also host theMedWand controlling software as well as facilitate communications withthe medical professional, either thorough audio or video and audio. Ifhosting the controlling software, then the user may also be able toperform limited control of the MedWand device 110, such as initiatingcalibration, and other user-defined operations, according to designpreference. One example would be to allow the user to authorizetransmission of his/her medical data and/or session data to the medicalprofessional or to another recipient 150 or to turn on/off a particularfeature.

While the MedWand device 110 is an “all-in-one” purposed device, it canalso communicate to other “medical” devices either directly integrated(e.g., physically coupled) or data coupled to the MedWand device 110,via separate device attachments, such as a stethoscope 60,lenses/Otoscope channel 70, Glucose Meter 80, Blood Pressure Cuff 90,etc. Some of these secondary medical devices/attachments can communicatewith the MedWand device 110 via a direct or wireless connection, usingthe MedWand device's 110 external link 105 as the portal to thephysician 150.

FIG. 1 also illustrates some of the hardware components “internal” tothe MedWand device 110, which in some embodiments comprise an optionalpower source (e.g., battery) 155, Micro-Computing Unit (MCU) 165 orother equivalent processing hardware with associated memory(EPROM/SDRAM, etc.) 170 and control/data signals 175 to internalhardware/sensors 180 supporting functions such as a Pulse Oximeter 184,Thermometer 186, Stethoscope 188, Otoscope with LED 190, etc., inaddition to external sensors, if so configured. Bluetooth 194 or othersimilar close-range wireless communication protocols are also enabled.

It should be appreciated that while FIG. 1 shows a given set of hardwarefor the internals of the Medwand device 110, other hardware components,different sensors, communication devices and so forth may beadded/removed according to design preference. For example, futureversions could include passive glucose monitoring as part of the pulseoximeter sensor set, and/or hemoglobin analysis. The MedWand device 110could be expanded to include direct Internet connectivity (by passingdata transfer through the computer/laptop 120), a more powerfulprocessor, a display and direct user interface to eliminate the need fora host computing device 120. Further, a fall detector or some othersensor device could be implemented as options or re-configuration of thecore unit.

FIG. 2 is a side view 200 of an exemplary MedWand device and show onepossible design configuration, wherein the principal sensors areintegrated into the device. Here, an Otoscope interface tip 290 isevident at the “front” of the device. As can be seen, this embodimentprovides a single, multi-sensor system that is compact and easy to hold,allowing a non-medically trained person to perform a preliminary medicalexamination with relative ease.

FIG. 3 is a bottom perspective view of the exemplary MedWand device ofFIG. 2, showing the stethosocope face 360 and also status and powerindicators 395.

FIG. 4 is another view 400 of the exemplary MedWand device 110, in useby a user. Here, a finger of the user's hand 410 is inserted into thePulse Oximeter's port 425. The Digital Stethoscope 460 is shown on the“bottom” of the MedWand device 110, but is understood to not be limitedto the bottom. The “tip” of the MedWand device 110 is configured with acamera 470 and LED(s) 490 for Otoscope functions, shown here with anear/nasal piece 498. A Thermopile (or similar) sensor and/or Thermometer(not shown) can also be facilitated to enable “in ear” temperaturereadings of the subject. Various power/communication cables 415,connection port 466 may be attached to the MedWand device 110. Statuslights, displays, switches and associated controls 495 can be placed ona side of the MedWand device 110, for user feedback, etc. FIG. 4 alsoillustrates a separate Glucose Meter 480 and Blood Pressure Cuff 493that is wireless capable, in communication with the MedWand device 110.It is evident from this Fig. that operation (from the user'sperspective) is very easy and that most of the basic health indicatorsensors are integrated into the MedWand device 110, with supplementalhealth sensors (480, 493, etc.) being in “communication” with theMedWand device 110.

FIGS. 1-4 illustrate a commercial embodiment of the MedWand device 110,with the respective elements/sensors shown at “particular” places on thedevice 110. However, it is understood that various elements/sensorlocations may be altered, changed and the shapes of the elements/sensorsmay be also altered, changed according to design preference, withoutdeparting from the spirit and scope of this disclosure. Also, theseFigs. show communication and power being supplied by a wired connection.In other embodiments, the communication may be transmitted wirelesslyand power may arise from an internal power source, such as a battery.

FIG. 5 is an illustration 500 of the “back end” interface of theexemplary system wherein information from the MedWand device ispresented to an examining professional. It is understood that sensordata for the examined person is forwarded from the MedWand device to asupporting server 130 (See FIG. 1) which then supplies a connection tothe examining professional. In some embodiments, the laptop/computer 120may have software that directly connects to the examining professional.The back end interface 500 contains patient and device information 510with visual windows for any camera/image data 550 and the medicalprofessional 560. In some embodiments, the medical professional imagemay be the user/patient (for example, from the medical professional'sperspective). The individually sensed (real-time or aggregated) medicaldata 530 is displayed and various controlling options for the medicalsensors are presented. Session options 570 are also presented. Theinterface provides a composite data window for the professional 560 toview and control the MedWand device, user's medical data, as well ascommunicate (via a computer/laptop) to the user.

In some instances, one or more of the medical data shown may be from adifferent examination or not originated from the MedWand device. As anon-limiting example, x-ray images maybe added to the interfaceinformation to provide the professional 560 the user's x-rayinformation. FIG. 5 is demonstrative of the exemplary embodiment'sability to perform a live streaming examination with as neededinformation (e.g., x-ray) with a medical professional without anyone butthe patient performing the instrument/sensor application. The breath ofmedical information that can easily obtained from the MedWand device issignificant, and the ability to integrate this information with anexamining medical professional is believed to be a significant shift inthe industry paradigm. Further, with the ability to communicate with thepatient, the medical professional can instruct the patient to performadditional examination activities (e.g., attach a separate detector,sensor, or deep breaths, etc.) while the patient is in the comfort oftheir own environment.

Evident in FIG. 5 is the suite of information available, for example,reference no. 530 shows medical data such as Pulse, SpO2, Finger Temp,Forehead Temp, Stethoscope, Otoscope, Glucose, Blood Pressure, image ofear or sinus 550, various sessions options 570, as well an image 560 (ifso desired) of the medical professional. As discussed above, thisinformation may be displayed on the medical professional's side, and/orsome aspects of the information may be displayed on the user/patient'sside. Also, while a laptop/computer may be the displaying platform, anysuitable device that provides the necessary display, communication/datacapabilities may be used. For example, a smart phone, tablet, PC, smartTV, and so forth.

FIG. 6 is a block diagram 600 showing various Software and Hardwareelements/modules and associated possible data paths in an embodiment ofa MedWand system. Patient data 610 (and optional external devices 620)are procured by the MedWand device 110 and forwarded to the Clientdevice 625 via a secure or encrypted link 628. The Client device 625 is“connected” to the system's Cloud 640 via a secure transport protocol648 and also “connected” to a medical professional (shown here as adoctor) via a secure teleconferencing protocol 658. The system's Cloud640 contains or manages the application services and also providesstorage, as needed. Information from the system's Cloud 640 is alsosecurely connected 668 to the Doctor's application 660, which is runningon the Doctor's device (not shown) or via a web-portal to the system'sCloud 640 service supporting the application 660.

System Cloud 640 also has access, if so configured, to Patient MedicalRecords 670 and to Mobile Alert Services 680, which sends an alert to aDoctor's application 690, informing the Doctor of an emergency orrequest to join a session, and so forth. These latter connections may ormay not be secure, depending on implementation preference. However, ifpatient information or other proprietary information is forwarded,secure protocols may be invoked. System Cloud 640 also has aspects of aManagement Portal 694 and Analytics engine 696, for maintenance,management, etc.

It should be noted that individual patent data from and to the system'sCloud 640 may be transferred to a provider PMR 670 with patient and/orDoctor approval. It should also be noted that data accumulated acrosslarge demographic and/or geographic populations is understood to bevaluable for predictive and preventive medicine. In some embodiments,the Analytics engine 696 may use this information, withde-personalization performed (to comply with privacy concerns, etc.) toobtain the predictive/preventive information.

Evident in FIG. 6 is the encryption between the client/patient portaldevice and the cloud storage and teleconference system, as well asbetween the cloud storage and the doctor-controlled MedWand deviceand/or doctor-used software. The “doctor” reviewing the MedWand data candecide what data is appropriate to retain and/or send to cloud storage.In some instances, mobile alert features may be triggered, for example,a senior doctor may be alerted to a threshold condition sensed by theMedWand device during an examination by another doctor or clinician. Orthe result of a self-initiated examination can trigger an alert to aphysician.

FIG. 7 is a functional block diagram 700 illustrating the variousmedical hardware, computer hardware, and communication hardware that canbe implemented in an embodiment of a MedWand user device. In anembodiment developed for commercial use, an ARM Cortex Wellness SOCprocessor 730 is used to host and manage the associatedsensors/indicators 710 and communications 750. Various integratedsensors (Pulse Ox, Temp, Bolometer, Stethoscope, Audio, Inertial,Camera, etc.) are “hard wired” to the processor's data/communicationinterface. Camera 720 is contemplated for focus/autofocusing of images.Battery 775 and/or power module 770 supports the processor 730 and anysensors 730 and communications and/or memory hardware 740, as necessary.Processor 730 drives provides data/information to User Interface 740,which is supported on the user client hardware (not shown). Ofimportance, is the recognition that a “single” device capable ofperforming the medical test procedures typically found in a healthcheck-up are integrated into the MedWand device, and produced in a formfactor that is easy to use by a patient.

FIG. 8 is a block diagram 800 illustrating the various medical hardware,computer hardware, and communication hardware that can be implemented inan embodiment of a MedWand user device. In an embodiment developed forcommercial use, an ARM Cortex Wellness processor 810 with memory 815 isused to host and manage the associated sensors 820 (Transreflective SpO2with Accelerometer, Temperature Sensor, ECG, Acoustic Pickup, Gyroscope,Microphone, Accelerometer), 830 (Camera Liquid Optic Autofocus) andsensor communications 840 (BlueTooth). A “Trust Protection Engine” 850is implemented to have hardware-based security for data being read/sentthrough the processor. In some embodiments, the “trust” engine 850 maybe software based or various portions off-loaded to the user'steleconferencing computer. Analog and Digital interfaces 860 areprovided o the processor 810. Multiplexer 870 is used to control videoas well as any USB in/out data. Additional capabilities are found in theanalog front end 880 and clocks/timers 890.

FIG. 9 is a web-portal snap shot 900 of an initial MedWand session,showing the MedWand Doctor's log-in procedure/prompting, and isunderstood to be self-explanatory. Commensurate log-in controls andsecurity protocols, used in the log-in procedure are within the purviewof one of ordinary skill in the art and therefore are not detailedherein.

FIG. 10 is a web-portal snap shot 1000 of subsequent steps in a MedWandsession, showing the session information, physician name, MedWand deviceid and/or serial no., Physician ID, session time and date. Patientinformation 1020 such as name, birth date, sex, photo (if available),contact information is also presented. Various other information may bepresented, to confirm the identity of the participants, equipment beingused, etc., as needed. This Fig. shows the MedWand device's SpO2information 1030 for the current patient. This information may behistorical or real-time.

FIG. 11 is a web-portal snap shot 1100 of subsequent steps in a MedWandsession, where it can be seen that a calibration or health/status 1110of the MedWand device is presented. Further, additional medical history1120 of the patient can be presented. In some instances, information ofthe patient's kin may be available, to determine if there is ahereditary trait that should be investigated.

FIG. 12 is a web-portal snap shot 1200 of subsequent steps in a MedWandsession, showing additional MedWand sensor data 1210, such as thetemperature of the patient and Otoscope.

FIG. 13 is a web-portal snap shot 1300 of subsequent steps in a MedWandsession, showing the pulse rate and blood pressure 1310 in graphicalform.

FIG. 14 is a web-portal snap shot 1400 of subsequent steps in a MedWandsession, showing the patient's temperature 1410.

FIG. 15 is a web-portal snap shot 1500 of subsequent steps in a MedWandsession, showing Otoscope video 1510 and stethoscope audio file 1520.

As should be apparent from the above web-portal snap shots, the MedWanddoctor/user interface is tailored to the MedWand device, and allows ahomogenous platform for rapidly, concisely performing a telemedicinesession, using the MedWand device as the primary medical sensorhardware. The ability for the doctor/professional to engage in real-timewith the patient and “conduct” an examination via the user's simplemanipulation of the MedWand device, having integrated sensors, and alsoexamine the sensor data (live or historical) in a secure environment, isnot seen in the prior art. The “ease” of use of such a configured systemcannot be overstated.

With the above Figs. setting the stage, there are two contemplatedscenarios under which a patient would use the exemplary integratedmedical device and system. The first involves a real-time telemedicinesession where the patient is connected via the Internet to a healthcareprovider. The integrated medical device is connected to a computingdevice allowing a teleconference with the healthcare provider. In thiscase, while the teleconference is in progress with the remote healthcareprovider, the integrated medical device facilitates real-timecollection, sharing and transmission of various vital signs andinformation for the provider. With HIPPA compliant secure linkage to asecure teleconferencing service and patient medical record storagefacility, the teleconference interface is built into the integratedmedical device user software on the user's computing device. (in someinstances, the software can be hosted on a server, being “displayed” onthe user's computing device.)

When the patient invokes a telemedicine conference, he/she is connectedin real-time to a healthcare provider (usually a doctor). The doctorwould be running the healthcare provider's version of the integratedmedical device software where he/she can see the integrated medicaldevice data and also take control of the device to invoke tests andreview data. Each vital parameter built into or passed through theintegrated medical device can be selected from the user interface on thecomputing device. For example, either the doctor or the patient may wantto measure the patient's pulse, SpO2, and finger temperature. The“Pulse” button/action is selected on the computing device. A help screenappears to guide the patient through proper usage or set-up for eachtest. When the test button is pushed or clicked on the user interface, acommand is sent to the integrated medical device through (in someexamples) the USB connection (or a wireless connection). Power for theintegrated medical device can be supplied via a physical USB connectionor via internal rechargeable battery depending on the version in use.Once the command is received by the USB interface, it is formatted andsent to the microprocessor (uP) in the device.

The second scenario would involve the patient collecting session dataand sending it up to the records storage location for later analysis bya healthcare professional outside of a telemedicine session. The doctorcan also set control parameters within the records storage applicationto monitor trends in the serial session data being sent by the patient,and be warned via electronic alarm to web enabled devices defined by thedoctor if the data trends outside of configured parameters. While onlytwo scenarios are described above, it is possible that additionalscenarios of the MedWand system may be developed, therefore, the aboveexamples should not be considered limiting, but be understood aspresenting only the most obvious scenarios.

In some embodiments, the integrated medical device may limit usage ofthe on-board tools, devices, and/or instrumentation to a maximum numberof tools that can be simultaneously used. For example, in someembodiments of the integrated medical device, only one sensor can be inuse at any given time, so in this example the uP sends appropriatecontrol signals over the PC bus to invoke a pulse Oximeter test. Thedata is returned to the uP where it is both stored in the sessioninformation in memory and sent back to the computing device via the USBconnection (or wireless). Each sensor has a different function and someinclude audio and video, which can be recorded or taken as a snapshot(video still), but the workflow is essentially the same for each oneexcept the Bluetooth devices, which may be connected to the integratedmedical device first.

Multiple sensors may be invoked to derive secondary measurements ofsignificant clinical value that cannot be derived from a single sensor.For example, the uP may invoke the pulse Oximeter and the digitalstethoscope operating under the control of a single unified, highlyaccurate reference clock for the purpose of measuring. Thus,simultaneous measurements can be made, with an understanding thatcorrelations between the measurements can be made.

For the integrated medical device to perform medical diagnosticoperations, a process is performed composed of several steps, including(1) receiving command from host computing device to invoke a test, (2)determining which sensor to wake up, (3) sending appropriate controlsignals to the appropriate sensor to perform the test, (4) determiningwhether the sensor has sent data related to the test (i.e., waiting toreceive data or has any data even been returned?) (5) after data isreceived, determine whether the data is within expected parameters(i.e., given the types of test, is the data in the expected range orreadings?) (6) when the data is within expected range, continue toprocess step 10 without retesting, (7) when the data is not withinexpected, then loop to retest, (8) informing host of test failure, (9)testing again, (10) saving data in session buffer, and (11) sending datavia output (e.g., USB) to computing device.

Practically speaking, the user may attach the integrated medical deviceto the host computing device and then invoke the integrated medicaldevice software or application to begin testing. Testing may be done byfollowing a set of on screen prompts. The patient, without anyassistance, may be able to take Pulse, SpO2, finger temperature, recordhis/her heart& lung sound, take pictures of his/her ear, nose or throat,record glucose readings and take blood pressure all from a singleintegrated device accessed through a single easy to use user interfaceon a PC, laptop, tablet or smart phone. Other Bluetooth-enabledelectronic devices (in addition to certain glucose and Blood Pressureunits, like a scale for example) could be added and supported as well.All of the data is collected and presented in an easy to read singlemedical record that can appended to any PMR system. This data can betracked, monitored and/or analyzed for trends or “out of control limit”readings. If connected to a health care profession during a real-timeteleconference the patient can elect to share all of the vitalsinformation as it is collected real-time simply by pressing the “sharelive” button on the interface. The doctor can also direct the patientfor proper readings and even invoke some of the tests remotely. At theend of a session the patient or doctor merely needs to press the savebutton to store the data in a secure file on the host device, and alsosave it to a remote cloud PMR archive if that service is invoked in thepatient profile.

It should be noted that due to security concerns, the information being“shared” on the respective display devices/platforms may simply bescreen images and not actual data, per se. For example, through HIPPAcompliant video conferencing system with screen share capabilities, thedoctor will be able to engage in a two-way videoconference as well asobserve all of the data reporting from the MedWand device. The doctorcan actually be viewing the patients screen through the screen sharefunction. The doctor is able to manipulate the MedWand device throughthe screen share interface that provides “remote control” capabilitiesof the patient's computing device/laptop, etc. During the exam however,no actual medical data is transferred across the Internet. What thedoctor sees is a video representation of the data reporting. During theexam the doctor is able to “tag” and select certain data sets reportedfrom the various sensors for recording and archiving in a remote recordset in the patients computing device. At the end of the session thetagged data is compressed, encrypted, and sent to the data storagecenter in a separate, single, secure transmission.

Data from the several discrete sensors on or attached to the integratedmedical device share a common control and data handling system. Datareturned by the sensor is stored in user specific patient records. Asession record is kept in memory on the device and test data is alsosent to the host computing device for further consideration and actionsvia the communications data link. Session data is formatted to present asingle, unified patient record of all vital signs, video and audio datacollected during a given session. The host computing device formats anddisplays that data for use by the doctor and patient medical recordsarchiving and analysis. In some versions of the integrated medicaldevice all communication with the host device may be by Bluetooth onlyand power would be provided by an on board rechargeable battery.

In addition to patient vital sign/physical testing, diagnostic analysiscan be performed. Algorithmic analysis, for example, can be performed tocorrelate one set of medical determinations with another. For instance,when the heart beats, the integrated medical device will pick up systoleacoustically via the digital stethoscope on the device. The speed ofsound in tissue is about 1500 m/s, so the device will pick it up inhundreds of microseconds. Then, using the pulse oximeter sensor, thedevice can see the systolic wave at the periphery (i.e., finger).Synchronous measurement of peripheral pulse (via the pulse oximeter) andcardiac acoustic signals (via the stethoscope) yields, at the veryleast, a phase delay between the two. This delay may by analyzedalgorithmically to correlate with blood pressure, capillarydilation/contraction, arterial elasticity, fluid responsiveness, et al.

In addition to the phase delay described above, use of the integratedmedical device allows for comparison of the character of a cardiacacoustic signal and the character of the plethysmographic wave at theperiphery (pulse ox wiggle) to yield other markers of clinicalsignificance. Further, cardiac acoustics and/or pulse ox can be furthercorrelated with motion/flush in the camera image (otoscope and/or webcam on the host). The image dynamics (color, tone, motion etc.),correlated with the other sensors as described above will yield otherdata points of clinical significance.

Logistically speaking, if no Internet access is available where thepatient is located, then the inventors have available an enterprisecalled MedWand Digital Health which offers the MedWand Global Clinic asa tool for remote connectivity. The MedWand Global Clinic connects adoctor to a patient anywhere on earth, even if it's a battlefield, ajungle, an oil rig, or any other remote place. Housed in a smallruggedized case that fits in the overhead space on an airplane, theGlobal Clinic has a MedWand device, a custom built super-ruggedizedtablet, a built-in satellite phone, 4G station, Wi-Fi and even its ownsolar power system.

To accommodate various “payer” programs and scheduling, the doctor andpatient profiles can be set in advance and driven (allowed to connect)by the various payer programs available throughout the system. This mayinclude insurance coverage, direct primary care, pay per exam or manyother possible doctor—patient relationships as defined by the particularhealthcare value proposition in use. A session may be between a patientand his/her primary care physician, a telehealth service provider, orwith any of an available pool of providers, depending on the program inuse. To facilitate the session, the doctor or provider can log into aninventor-provided MedWand Telehealth Conference System to post availableclinic hours. These hours can be posted and/or modified up to, forexample, six months in advance.

Various examples of an actual implementation are presented. In onepossible implementation, the patient logs into the same conferencesystem with their unique patient ID and password to view availableappointment times, and selects an appropriate appointment with thedesired doctor or provider approved and pre-authorized by the system.Appointments may be scheduled, for example, two minutes to six monthsahead in time. The patient will receive a reminder, for example, viaboth e-mail and text message in advance of the scheduled session. Atappointment time (actually a predefined number of minutes before, as thepatient appointment time and doctor availability are offset 5 (or other)minutes by the system to allow for patient log in and reduce doctorwaiting time), the patient logs into the system and registers for theexam session via an interactive “virtual waiting room”. The patient isprompted at this time to be sure their MedWand is connected and ready.

The doctor will see the patient in his/her virtual waiting room on thedoctors PC, including all available information on the current reasonfor the visit and a link to the patient's medical history (ifavailable). When the doctor is ready he/she will start the exam sessionwith a single button selection.

The Exam

When the session begins, a two-way videoconference is established. Thedoctor will also see the status of the MedWand device and the sensorselection options within the application. The MedWand device alsoprovides visual feedback of its status to the patient via an indicator,for example, amulti-colored LED array. The doctor can select any of theavailable sensors, in no required order.

Otoscope (Camera):

Located on the front of the MedWand device, the otoscope is a highdefinition camera with several attachment options (specula) that affixmagnetically to the front of the device. The attachments are designed toaid in the viewing of various parts of the body including inside theear, eyes, nose, throat and skin. The depth of focus can range fromabout 50 mm from the sensor plane to over 200 mm. Some of theattachments may contain additional lenses for enhanced viewing options.Camera pan, tilt and zoom are all controllable by the doctor through thevideo interface. Focus is automatic through a dynamic liquid lenssystem, or other equivalent.

Illumination is provided via an array of LED's located around the camerasensor, some which may be infrared capable. Therefore, dual or multipleillumination capabilities are contemplated using multiple arrays, theintensity being adjustable by the doctor for each array. Under infraredoperation the otoscope can operate as an ophthalmoscope. The intensity(brightness) can be adjustable through a slider on the doctors' side ofthe application. At any time during the use of theotoscope/ophthalmoscope, the doctor can initiate a live video recordingor take a snapshot of the content being viewed by the camera.

Stethoscope:

Located on the lower portion of the MedWand device, the stethoscope is adigital audio pick-up device that transmits a digitized audio signal tothe MedWand processor. The audio stream is transferred real-time to thepatient's computing device when selected as the active sensor. Thedoctor can monitor the stethoscope audio OR converse with the patientthrough a “push-to-talk” button on the doctors' interface that togglesthe patient's audio input device selection from the MedWand device tothe local computing device. At anytime the doctor can initiate an audiorecording of the stethoscope pick-up. The doctor can select the durationof the recording or operate it manually. If no “stop” selection is madethe sensor disconnects when another sensor is selected or the doctorreturns to two-way voice communication with the patient.

Pulse Oximeter (SpO2):

There can be two pulse oximeters on the MedWand device. Primary (SpO2-1)is located on the top of the MedWand device for use by inserting theforefinger into the pathway for a reading. The second unit (SpO2-2) canbe on the bottom of the MedWand device near the stethoscope pick up.Only the primary SpO2 sensor can be selected by the doctor in normal,single sensor operation mode. When a satisfactory reading is obtainedthe doctor can take a time stamped snapshot of the oxygen saturation andBPM data for inclusion into the exam data set. The SpO2 sensor can be ofa design that also registers ECG signals.

IR Thermometer:

There is an Infrared thermometer located in the tip of the MedWand. Itis designed for non-contact application and can come with attachments toenhance its performance, for example, non-forehead measurement uses,etc. Once a suitable reading is obtained the doctor can save it forinclusion into the exam data set.

ECG:

The MedWand device can contain a single/multiple channel, multiple lead(e.g., 2 lead) ECG system. Pickups can be on the bottom of each unit foreach forefinger. There are two pickups on the lower part of the unit ateither end of the stethoscope housing. The doctor can elect to start andstop an ECG recording at any time once proper contact is established.The duration can be set manually or predetermined in the doctor'sapplication.

Bluetooth:

The MedWand device contains a Bluetooth radio and can be paired with anyapproved Bluetooth device. The profiles for approved devices, and theirassociated GUI's are loaded into both the patient and doctorapplications. Therefor, when a Bluetooth device is paired with theMedWand device, it notifies the application which exact device isavailable. That device is then presented to the doctor as a sensorchoice and will indicate for example: “Blood Pressure Cuff viaBluetooth”. The doctor can then choose to save and data available fromthe remote device for inclusion into the exam data set.

Multi-Sensor Session

The MedWand device is designed to take simultaneous readings frommultiple on-board sensors during a single placement on the body, usuallythe chest area above the heart. Specifically, the Stethoscope, ECG, thefingertip pulse oximeter and the chest pulse oximeter. This yields 12possible correlation points that can be applied to advanced correlationalgorithms. By correlating these readings in time and by otherattributes such as amplitude and distortion, we can detect a multitudeof medical states and conditions including fluid responsiveness, fromwhich relative blood pressure can be derived. This is new territory.Some academic studies have been done on this subject and suggest thatmuch deeper and meaningful diagnosis can be derived from correlatedsimultaneous sensor data.

Data Transmission

Once the exam concludes, the data the doctor selected for inclusion inthe exam data set is formatted, compressed and encrypted into a singlefile. This file includes all of the preserved data reporting, and alsoall of the information pertinent to the exam including the patientprofile and identifiers, doctor information, insurance claim informationif appropriate, MedWand serial number and software revision, plus time,date and location stamps for the exam.

The data is automatically sent to the MedWand Digital Health cloud basedsecure data repository as an exam record for that patient by thepatients computing device automatically in the background. The doctor isimmediately notified that the exam data is available for review andnotation through the MedWand application that includes the appropriatedecryption and encryption tools. At his/her discretion the doctor cancall the exam summary and make notations, both general and specific toeach preserved observation. The record can be downloaded to the doctorsPMR record or uploaded to a 3rd party PMR record. MedWand's datarepository presents the exam data file in a standard format that can bemapped into any PMR system if the system owner is provided with the dataattributes and decryption tools from MedWand Digital Health.

Case Scenarios for MedWand

The following is a list of some possible conditions that MedWanddevice/system can be used to aid in diagnosis from a remote location.Note that most cases require more than one sensor. MedWand is understoodto be the only device that consolidates all of these sensors into asingle handheld device and then creates a consolidated medical recordfor the exam.

Diagnosis of Asthma Exacerbation/Acute Asthmatic Episode

MedWand Features Used:

-   -   SpO2    -   Respiratory Rate    -   Stethoscope

Diagnosis of Inner Ear Infection (Otitis Media)

MedWand Features Used:

-   -   Thermometer    -   Otoscope

Diagnosis of Outer Ear Infection (Otitis Externa)

MedWand Features Used:

-   -   Thermometer    -   Otoscope

Diagnosis of Seasonal Allergic Rhinitis

MedWand Features Used:

-   -   Otoscope (into nasal cavity)

Diagnosis of Conjunctivitis

MedWand Features Used:

-   -   Otoscope (over eye)

Diagnosis of Bronchitis

MedWand Features Used:

-   -   Stethoscope    -   Thermometer    -   Respiratory Rate    -   SpO2

Diagnosis of Pneumonia

MedWand Features Used:

-   -   Stethoscope    -   Thermometer    -   Respiratory Rate    -   SpO2    -   Heart Rate    -   Blood Pressure (via Bluetooth)

Initial Diagnosis of Congestive Heart Failure Exacerbation (subsequentconfirmation required)

MedWand Features Used:

-   -   SpO2    -   Stethoscope    -   Respiratory Rate    -   EKG    -   Weight (via Bluetooth)

Initial Diagnosis of Acute Myocardial Infarction (subsequentconfirmation required)

MedWand Features Used:

-   -   EKG    -   Heart Rate    -   Respiratory Rate

Initial Diagnosis of Septic Shock (subsequent confirmation required)

MedWand Features Used:

-   -   Temperature    -   Heart Rate    -   Blood Pressure (via Bluetooth)

Initial Diagnosis of Hypovolemic Shock (subsequent confirmationrequired)

MedWand Features Used:

-   -   Heart Rate    -   Blood Pressure (via Bluetooth)

Initial Diagnosis of Hyperglycemic/Diabetic Shock (subsequentconfirmation required)

MedWand Features Used:

-   -   Glucose reading (via Bluetooth)    -   Blood Pressure (via Bluetooth)    -   Heart Rate    -   Respiratory Rate

In a prototype version, the MedWand device was configured to have theability to take multiple sensor readings simultaneously and report themas a unified data set, with the data corrected for processing andformatting time. Specifically, four sensors were monitoredsimultaneously and the time delays and characteristics (absolute values)between the occurrences of the sensor data were compared to indicate thefluid responsiveness of the human body as well as several otherphysiological dynamics. Coupled with other discrete readings such asbody mass, even more correlated data can be accumulated and subjected toa diagnostic algorithm from which health metrics can be derived,including blood pressure (and many others). The four sensors in theprototype included:

-   -   EKG (minimum of 3 lead).    -   Acoustic occurrence of heart valve sounds at the outer chest        wall (digital Stethoscope)    -   A Pulse Oximeter located at the fingertip detecting oxygen        saturation and pulse.    -   A sensor located at the fingertip detecting heart rate and heart        rate variance from which pulse transit time can be derived in        conjunction with the ECG and stethoscope Monitoring these and        other potential sensors create multiple data points for        correlation and subsequent analysis. A recent version of sensors        utilizes a pulse oximeter that also measures heart rate variance        and respiratory rate, therefore less independent sensors can be        used as well as more sensors, depending on sensor type.

FIG. 16 is a plot 1600 of a representative EKG signal detected by theMedWand system. It is understood that each stroke of a cardiac chambercreates a pressure wave that propagates/dissipates through thecirculatory system and soft tissues. If we have a “starting gun” fromthe EKG signal at the beginning of a ventricular contraction, ‘R’, 1610then we can look ‘downstream’ (at a number of different locations) atthe PPG (photoplethysmograph) signal, as further described below. Themarker P 1620 represents the atrial depolarization P-wave, QRSrepresents the period 1630 of depolarization of ventricles, PR segment1640 represents the delay of AV node, ST segment 1650 represents thebeginning of the ventricle repolarization, T 1660 the ventricularpolarization, and U 1670 represents secondary activity.

FIG. 17 is a description of a PPG signal 1700 detectable by the MedWandSystem. What the PPG signal indicates is that the first thing to look atis the delay between the Rwave 1710 and the systolic peak (marked justas ‘PEAK’ 1720 in this Fig.). The speed of sound in human tissues isvery close to that of the speed of sound in water, about 1550 m/s. Asblood is relatively incompressible—even while being full of soft tissue(erythrocytes) and dissolved gas—we would expect the speed of soundrelationship to hold to first approximations. So, a meter worth ofdistance should be 1/1550 worth of time=0.65 ms. Considering, per FIG.17, that human heart rates can't go much higher than 4 Hz (240 bpm), theperiod between two peaks must be less than ¼=250 ms. As such,‘transmission time’ in fluid is not a significant contributor to thedelay between the Rwave and the systolic peak. Then what is causing thedelay? It is believed to be a combination of Elasticity (tissue) andDamping (tissue and fluid shear loss).

If the tissues surrounding the CV had no elasticity, the heart wouldhave to push harder, but blood flow would be instantaneous. With thiselasticity, there is a delay, and a ‘smoothing’ of the input functionfrom the ventricular contraction.

When the CV tissues, and the tissues surrounding them, stretch andrelax, there is loss (visco-elastic damping) involved. As well, there isviscous loss in the bloodstream and between the bloodstream and thewalls of the CV system. This is a function of wall area. As we get downto the capillary level, wall area goes way up. The overallheart/CV/tissue system can be seen as a mechanical driver attached to amass/spring/damper system—at least a second-order system, to allow forthe clear delay between the Rwave and the onset of pulsatile flow in thePPG.

FIG. 18 is a diagram 1800 of a theoretical model of a heart, withrespective mechanical equivalences. For example, the CV/tissue systemfor a given unit length can be represented as an elastic series ofdampeners 1810 with accompanying restorative springs 1820, betweensegments 1830 being operated on by the Heart and PPG. Models like thiscan be characterized with standard harmonic motion equations andcoefficients—K1, K2 . . . G1, G2, . . . , etc. Deriving the coefficientsfrom this model for a given EKG/PPG dataset could yield numericalmatrices, which can be correlated with blood pressure.

Using the above information, we can apply a certainmechanical/mathematical model to the data, and derive a set ofcoefficients. Those sets of coefficients, for a given patient, maycorrelate with blood pressure. With additional demographic/health data,it may be possible to correlate a blood pressure number (in mmHg) to agiven individual that is as accurate as cuff-based current practice. Forexample, it is believed that the exemplary system, with the heartmodeling, the relative phase-delay between various distal locationscould be used to detect asymmetries in the CV system or possibleindications of arterial blockage. Aspects of the above analysis isreferred to in the MedWand parlance as “Point to Point” Blood Pressure,or “Multi-Point Blood Pressure Analysis” or “BPsquared.”

FIGS. 19A-C are front perspective view, front view, side view and bottomview illustrations of another embodiment of an exemplary MedWand device1900. The following discussion will be in reference to the combinationof FIGS. 19A-B. This device 1900 is a variation of the embodimentsdescribed above, principally differing in the housing shape andarrangement of sensors, finger “port”, etc. Device 1900 comprises ahousing 1910 that is primarily oblong in shape and sized to fit underthe palm of a user. The microprocessor, sensor electronics and wiringdescribed herein are sealed within the housing with only the sensor“pads” or detectors being exposed on the exterior faces of the housing1910. Thus, the sensors are integrated into the housing 1910 and use ofthe sensors can be made by simply touching the appropriatesensor-containing face of the housing to the desired body part. Further,the overall shape of the housing 1910 is smooth to avoid sharp orprotruding surfaces that may injure the user. The material compositionof the housing 1910 can be such that it can be cleaned and disinfectedwith common ingredients without affecting the sensors.

In a prototype embodiment, the device 1900 was approximately 128 mmlong, 64.3 mm wide, and 60.7 mm tall. And weighed approximately 165grams. Of course, in commercial or alternative embodiments, the physicalsize, proportions, and weight may be altered, according to designpreference. However, the exemplary device 1900 is designed to be useablewith a single hand use and therefore, the sizing and weight is such toallow a person to grip the device 1900 with his/her hand. Housing 1910is symmetrically designed for either left or right hand use, withoutloss of functionality. The housing shape is purposely designedunderstanding that in some situations, the user may have difficultyholding a pen-shaped device (due to arthritis or other hand, fingerimpediments), therefore, the uniqueness of the housing shape and sizeallows for elderly and even younger users to manipulate the device 1900with ease, as well as allowing rapid switching from one hand to theother.

To this end, the housing 1910 has an upper shape 1950 that is doomed orcurved, to allow for easy gripping by one hand of a user, wherein thepalm of hand can comfortably rest on the upper curved shape 1950. Thebottom 1930 of the housing 1910 is substantially planar or flat to allowa suite of “bottom” sensors disposed therein to easily be used upon auser's person, without interruption from any protrusions from thehousing 1910.

The upper doomed surface 1950 is punctuated with a longitudinal recess1940 with a forward “camera-side” region 1942 that contains one or morepulse oximeters 1945. The recess 1940 is on the top portion of thehousing 1910 and is wide enough to fit one or more fingers of a user,laid longitudinally within the recess 1940. Not shown here, but in someembodiments a front of the recess 1940 may be covered by lip or hood ofthe housing, so the tips of person's finger(s) may be under the lip.This optional “lip” arrangement will make a users' finger(s) less likelyto slip out of the recess 1940.

At front, bottom portion of the housing 1910, is a slot 1965 into whicha dermatoscope spacer or tongue depressor (not shown) can be inserted.It is tapered inward for a positive grab of the tongue depressor.Traversing the sides of the housing 1910 is an optional seal 1912 whichcovers a seam (not shown) from the joined upper and lower portions ofthe housing 1910. The seal 1912 can be made of a compound that providestactile control and gripping surfaces for a user's fingers, for example,rubber, silicone, etc. At the front of the device 1900, is a camera 1920with a series of lights (e.g., LEDs) 1924 disposed about the camera 1920(shown here in a circular arrangement, but it is understood that otherarrangements may be utilized). The exposed surface of the camera 1920may be covered with a removable lens (e.g., polarizing, protective, UVfilter, etc.). Surrounding the lights 1924 is a hood 1925 that protrudesfrom the housing 1910 and provides a surface “contact barrier” to thecamera 1920. Hood 1925 can contain detents 1926 or couplers to allow forattachment of various otoscope facilitating implements (e.g.,Welsh-Allen ear, nose, etc. piece). In some embodiments, the hood 1925may be removable, whereas such implements may be attached directly tothe front of the housing 1910 without using the hood 1925.

It should be recognized that the camera 1920 is situated at a specificlocation on the housing 1910, that is, it is generally in-line with thelongitudinal axis of the recess 1940, so that a user's finger placed inthe recess 1940 will be approximately in-line (and elevated) from thecamera 1920. This design is so that the camera 1920 can be “guided” bythe user's finger, thus imitating the well-practiced and accurate motionof pointing with the finger. Accordingly, the natural motion offinger-pointing can be replicated to provide increased ease of use andimportantly, a greater degree of pointing accuracy when utilizing thecamera 1920.

Moving onto FIG. 19C, the bottom of the device 1900 contains a suite ofsensors, stethoscope 1932, ECG (pads) L-R sensors 1934 a, 1034 b,infrared sensor 1936, generally laid out in-line with each other. Thestethoscope sensor 1932 is centrally located with the ECG sensors 1034a,b placed on opposite sides of the stethoscope sensor 1932. Thisarrangement allows the individual ECG sensors 1034 a,b to be displacedat extreme distance from each other to achieve proper angle(s) on theheart or chest area.

A non-contact capable infrared temperature sensor 1936 is placed at therear and bottom of the device 1900 to provide maximum separation andisolation from the camera 1920 (which is located at the front of thedevice). The IR sensor 1936 is designed to be able to compensate forambient temperature. Port 1960 is a data and power port. Typically, butnot necessarily, port 1960 can be a USB port or other type power/dataport. Elements 1916 are simply screw hole covers.

FIG. 20A is an illustration showing a user's hand 2000 with thumb 2010and index finger 2020 gripping the exemplary device 1900, and isunderstood to be self-explanatory.

FIG. 20B is an illustration showing a user's hand 2000 with index finger2020 placed within the camera 1920 side sensor region 1042 containingthe pulse oximeter(s) 1945 (not shown) of the exemplary device 1900.This illustration shows a non-gripping method for use of the pulseoximeter(s) sensors. It is noted that middle finger 2030 can be usedinstead of the index finger 2020.

FIG. 21 is an illustration of temperature measuring mode of the device1900 where the IR sensor 1936 is gripped by a user's hand 200 andscanned across the user's forehead 2100.

It should be appreciated that the exemplary housing design in thevarious MedWand embodiments enables a user to operate the measurementsystem by simply placing the appropriate part of the sensor exposed faceof the housing onto (about) the body part being examined. There is noneed for wired sensors and the complications that come from handlinglong wires. The arrangement of the SpO2 sensor at the top of thehousing, so as to naturally align with an index or middle finger“holding” the device with the other fingers, the device lends itself fora more natural, easy, and ergonomic mode of usage.

In some embodiments, one or more of the medical diagnostic tools,devices, or instruments of the integrated medical device could bereconfigured or adapted for use in veterinary medicine. Furthermore,continuous data accumulated over time can be very valuable for researchpurposes. In the case of medical data it can be used for many kinds ofanalysis including predictive medicine and monitoring of populations bygeographic and/or demographic conditions. The integrated medical devicehas the ability to collect this type of data and transfer it tocomputing devices that can execute deep statistical analysis, making thedata itself very valuable.

While the above-described embodiments have been described with referenceto numerous specific details, one of ordinary skill in the art willrecognize that modifications and changes can be made without departingfrom the spirit of this disclosure. Thus, one of ordinary skill in theart would understand that the invention is not to be limited by theforegoing illustrative details, but rather is to be defined by theappended claims

What is claimed is:
 1. A compact, integrated, portable, diagnostic,multi-sensor telemedicine device, comprising: an oblong hand-heldportable housing, the housing having an upper surface with a domedshape, the upper surface having a longitudinally oriented recess, therecess adapted for placement of a user's finger therein, the housingalso having a bottom surface with a planar shape; one or more pulseoximeter sensors integrated into a front end of the recess, adapted tomeasure at least one of an oxygen saturation, heart rate pulse, heartrate variance, ECG, and respiratory rate of a user; an otoscope camerasensor and a light source arranged peripherally to the otoscope camera,integrated into at a front end of the housing and substantially in-linewith a center line of the recess; a non-contact capable infraredtemperature sensor integrated into at the bottom surface of and a rearend of the housing, adapted to measure a temperature of the user; adigital stethoscope microphone sensor integrated into the bottom surfaceof the housing, adapted to capture sound signals of the user'sheartbeat; a pair of EKG sensors integrated into the bottom surface ofthe housing, the sensors arranged on opposite sides of the stethoscope,wherein each of the above sensors' wiring and electronics are internalto the housing and non-accessible by the user; and a low powermicro-controller unit (MCU) in the housing, communicating directly orindirectly with the above sensors and forwarding an encrypted data fromthe sensors to an external Internet-connected or Cellular-connectedcommunication device, via at least one of a wired and wirelessconnection.
 2. The device of claim 1, further comprising an otoscopehood disposed on the housing and about the otoscope camera, the hoodhaving detents or attachment fixtures to enable a mounting of anotoscope ear, throat or nose piece.
 3. The telemedicine device of claim1, wherein at least one of the otoscope camera and light source areinfrared capable.
 4. The telemedicine device of claim 1, furthercomprising a computer with teleconferencing capability coupled to thetelemedicine device and having at least one of an Internet connectionand cellular connection to a remote server receiving the encryptedsensor data from the computer.
 5. The telemedicine device of claim 4,further comprising a software program running on the teleconferencingcomputer, providing teleconferencing with a medical professional,wherein the encrypted sensor data is presented to the medicalprofessional.
 6. The telemedicine device of claim 5, wherein thesoftware program displays the user's sensor data comprising at least oneof pulse information, SpO2 information, temperature, stethoscopereading, and otoscope reading.
 7. The telemedicine device of claim 6,wherein the software program further displays glucose reading and bloodpressure reading.
 8. The telemedicine device of claim 1, wherein thedevice includes at least one of Bluetooth, near field, and USBcommunication capability.
 9. The telemedicine device of claim 1, whereinthe device's camera includes a focusing lens.
 10. The telemedicinedevice of claim 1, further comprising at least two led arrays, one ofthe arrays being infrared.
 11. The telemedicine device of claim 4,wherein the server operates as a HIPPA compliant cloud storage unit. 12.The telemedicine device of claim 1, wherein the device is self-poweredvia an internal battery.
 13. The telemedicine device of claim 1, whereinpower for the device is via a USB connection.
 14. The telemedicinedevice of claim 4, wherein the remote server has access to a database ofPatient Medical Records.
 15. The telemedicine device of claim 4, whereinthe remote server provides encrypted information from a database ofPatient Medical Records and stored user sensor data to the medicalprofessional.
 16. The telemedicine device of claim 4, wherein remoteserver initiates a mobile alert to the medical professional or to asecond medical professional.
 17. The telemedicine device of claim 5,wherein the software program allows the medical professional to contactand share user data with a second medical professional.
 18. Thetelemedicine device of claim 5, wherein the software program allows themedical professional to contact a second medical professional to join inthe teleconference.